Yuichiro Maekawa

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Background: Post‐PCI vessel quantitative flow ratio (QFR) and QFR virtual pullback (QVP) index reflect postprocedural physiological quality and the residual disease pattern after percutaneous coronary intervention (PCI), but their associations with very‐long‐term vessel‐oriented composite endpoint (VOCE) remain uncertain. Aims: We examined whether the relationships of post‐PCI vessel QFR and QVP index with vessel‐oriented outcomes differed over time. Methods: We retrospectively reconstructed a 2010–2011 PCI cohort and expanded follow‐up to 12 years. Among 900 treated vessels/lesions, 595 with analyzable post‐PCI QFR were included. Kaplan−Meier curves with a 2‐year landmark, restricted cubic splines, and multivariable Cox models were used to compare determinants of 2‐year versus overall VOCE. Results: Among 900 treated vessels/lesions, post‐PCI vessel QFR was analyzable in 595 (573 patients; 575 procedures). Mean post‐PCI vessel QFR was 0.93 ± 0.07, and 76.0% of vessels achieved post‐PCI vessel QFR ≥ 0.91. Kaplan−Meier estimated 2‐year VOCE was 1.9% (11 early events). Neither post‐PCI vessel QFR nor QVP index was significantly associated with 2‐year VOCE in restricted cubic spline analyses (P for overall association = 0.175 and 0.449, respectively; P for nonlinearity = 0.281 and 0.478, respectively) or in conventional Cox models. For overall VOCE, age and diabetes mellitus were the dominant correlates. Conclusions: In this imaging‐intensive historical PCI cohort with few early events, neither post‐PCI vessel QFR nor QVP index demonstrated a statistically significant association with 2‐year VOCE. Very‐long‐term VOCE was more strongly related to age and diabetes mellitus, and the present findings do not establish a role for post‐PCI QFR‐derived indices in early risk stratification.

Background: Pulmonary vein isolation (PVI) alone was less effective for patients with persistent atrial fibrillation (AF) compared to those with paroxysmal AF. Although the TAILORED AF trial demonstrated the efficacy of spatio‐temporal dispersion electrogram (STDE) ablation as additional treatment for PVI, comparisons between STDE and low‐voltage zone (LVZ) remain unclear. We compared the efficacy of two different methods beyond PVI: the STDE and the LVZ ablation. Methods: This retrospective observational study included 107 consecutive patients (median age, 71 years; 79 male) who underwent initial catheter ablation for persistent AF at our institution. STDE evaluation and STDE‐guided substrate modification were performed in the STDE ablation group ( n = 53). The historical control group ( n = 54) did not undergo STDE evaluation and received additional ablation based on the LVZ. The primary endpoint was the recurrence of atrial arrhythmias after the ablation up to 24 months, with a 3‐month blanking period applied. Results: The number of additional ablations, including linear ablation, posterior wall isolation, and focal ablation, was significantly higher in the STDE group. The AF‐free survival rate at 24 months follow‐up after ablation was higher in the STDE group (76.3% vs. 58.4%; p = 0.027). In the multivariate Cox proportional regression analysis, prolonged AF duration (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.16–1.61; p < 0.001) and larger left atrial size (HR: 1.11, 95% CI: 1.02–1.20; p = 0.012) were independent predictors of AF recurrence. Conversely, STDE ablation was independently associated with a significantly lower risk of recurrence (HR: 0.29, 95% CI: 0.12–0.66; p = 0.004). Conclusion: STDE was associated with a lower risk of AF recurrence than PVI with LVZ ablation.

Summary This multicenter retrospective cohort compared romosozumab outcomes between oral glucocorticoid users and non-users. Bone turnover marker responses and lumbar spine bone mineral density gains were similar, whereas total hip bone mineral density gains were smaller among glucocorticoid users. Purpose To investigate the impact of oral glucocorticoids (GC) on the effectiveness of romosozumab by comparing outcomes between GC users and non-users after adjusting for patient background. Methods This multicenter, retrospective cohort study analyzed patients who completed 12 months of therapy (n = 428). Inverse probability of treatment weighting was employed to construct a pseudo-population with balanced baseline characteristics, yielding 40 GC users and 39.8 non-users (95.3% female, mean age 76.6 years; mean lumbar spine T-score -2.7; mean GC dose 5.4 mg/day [prednisolone equivalent]). Percentage changes in bone turnover markers (BTMs) and bone mineral density (BMD) over 12 months were compared between groups. Factors affecting BMD changes were identified using multivariable analysis. Results GC use did not significantly affect the changes in PINP and TRACP-5b levels. The 12-month increase in lumbar spine BMD was comparable between groups (GC users 9.7% vs. non-users 10.7%; P = 0.55). In contrast, the increase in total hip BMD was significantly lower in GC users compared with non-users (2.8% vs. 5.6%; P = 0.003). Multivariable analysis revealed that baseline PINP was significantly associated with the BMD increase at the lumbar spine, whereas daily GC dose was a significant factor for the total hip. Conclusion Oral GC use did not significantly affect changes in BTMs or BMD increases at the lumbar spine. Smaller gains in total hip BMD were observed in GC users, which may have reflected not only GC use but also underlying disease-related factors.

Objectives: To investigate the effectiveness of denosumab (DMAb), teriparatide (TPTD) and romosozumab (ROMO) in patients with glucocorticoid-induced osteoporosis (GIOP). Method: This multicenter, retrospective cohort study employed propensity score matching to select 42 patients per treatment group [92.1% female, mean age 73.5 years, 35.7% osteoporosis treatment naive, oral glucocorticoids (prednisolone equivalent) 5.4 mg/day, baseline bone mineral density (BMD) T-scores: lumbar spine (LS) −2.5]. Bone turnover markers (BTMs) and BMD were assessed over 12 months. Results: DMAb suppressed BTM levels, whereas TPTD increased them. ROMO showed a dual effect, with increased and decreased levels of formation and resorption markers, respectively. At 12 months, LS BMD increases were greater with ROMO (9.5%) and tended to be higher with TPTD (8.4%) compared with DMAb (4.4%) (P = 0.008 for ROMO vs DMAb). At 6 months, total hip BMD increased with DMAb (2.6%) and ROMO (1.8%) but decreased with TPTD (−0.6%; P = 0.01 for DMAb vs TPTD; P = 0.042 for ROMO vs TPTD); no significant differences were observed at 12 months (3.2%, 2.6%, 2.2%, respectively). DMAb showed significant increases in femoral neck BMD at 6 (2.2%) and 12 (3.0%) months from baseline. Conclusion: BTM levels reflected expected pharmacological actions of each drug. ROMO showed greater LS BMD gains than DMAb, while TPTD demonstrated a similar response, whereas DMAb may provide earlier benefits at cortical-rich sites. These findings underscore the importance of site-specific, individualized treatment strategies for GIOP.

Introduction: The relationship between myocardial lipid metabolism and disease phenotypes, genetic variation, and prognostic factors in patients with hypertrophic cardiomyopathy (HCM) remains largely unexplored. This study aimed to clarify how metabolic remodelling relates to disease phenotypes in HCM. We used desorption electrospray ionization imaging mass spectrometry (DESI-IMS) to compare myocardial lipid signatures in patients who required septal reduction therapy (SRT) and those who did not. Methods: In this prospective study, patients with HCM undergoing either right-ventricular biopsy or surgical septal myectomy were enrolled. Frozen 10 µm sections were analysed using DESI-IMS, and mass spectra were compared with volcano plots after signal-intensity normalization. Candidate ions showing |log2 fold change| ≥ 1 and P < .05 were annotated using the Human Metabolome Database. Results: Overall, 61 patients were analysed (34 [55.7%] were female; mean age 64.5 ± 15.9 years). Of these, 43 (70.5%) had obstructive HCM and 20 underwent SRT (SRT, n = 20; non-SRT, n = 41). The SRT group displayed a 3.3-fold higher signal for m/z 463.23, identified as testosterone glucuronide (P < .001). SRT remained the only predictor of elevated testosterone-glucuronide intensity in confirmatory regression (β = 1.991, P = .004), even after adjusting for age at diagnosis and the presence of hypertension, which significantly differed in baseline characteristics between the SRT and non-SRT groups. Conclusion: DESI-IMS revealed selective accumulation of testosterone glucuronide in hypertrophied myocardium from patients needing SRT, suggesting that androgen-linked metabolic remodelling plays a role in advanced obstructive physiology in HCM.